DHS 105.19(7m)(7m) Electronic visit verification. The nurse is required to capture and retain EVV records. DHS 105.19(8)(a)(a) A recipient’s nurse shall designate an alternate nurse to provide services to the recipient in the event the nurse is temporarily unable to provide services. The recipient shall be informed of the identity of the alternate nurse before the alternate nurse provides services. DHS 105.19(8)(b)(b) The nurse shall document a plan for recipient-specific emergency procedures in the event a life-threatening situation or fire occurs or there are severe weather warnings. This plan shall be made available to the recipient and all caregivers prior to initiation of these procedures. DHS 105.19(8)(c)(c) The nurse shall take appropriate action and immediately notify the recipient’s physician, guardian, if any, and any other responsible person designated in writing by the patient or guardian of any significant accident, injury or adverse change in the recipient’s condition. DHS 105.19(9)(9) Discharge of the recipient. A recipient shall be discharged from services provided by the nurse upon the recipient’s request, upon the decision of the recipient’s physician, or if the nurse documents that continuing to provide services to the recipient presents a direct threat to the nurse’s health or safety and further documents the refusal of the attending physician to authorize discharge of the recipient with full knowledge and understanding of the threat to the nurse. The nurse shall recommend discharge to the physician and recipient if the recipient does not require services or requires services beyond the nurse’s capability. The nurse provider shall issue a notification of discharge to the recipient or guardian, if possible at least 2 calendar weeks prior to cessation of skilled nursing services, and shall, in all circumstances, provide assistance in arranging for the continuity of all medically necessary care prior to discharge. DHS 105.19(10)(a)(a) Record review. The department may periodically review the records described in this section and s. DHS 106.02 (9), subject only to restrictions of law. All records shall be made immediately available upon the request of an authorized department representative. DHS 105.19(10)(b)(b) In-home visits. As part of the review under par. (a), the department may contact recipients who have received or are receiving MA services from a nurse provider. The nurse provider shall provide any identifying information requested by the department. The department may select the recipients for visits and may visit a recipient with the approval of the recipient or recipient’s guardian. The recipient to be visited shall be given the opportunity to have any person present whom he or she chooses during the visit by personnel of the department or other governmental investigating agency. DHS 105.19(10)(c)(c) Investigation complaints. The department may investigate any complaint received by it concerning the provision of MA services by a nurse provider. Following the investigation, the department may issue a preliminary final report to the nurse provider in question, except when doing so would jeopardize any other investigation by the department or other state or federal agency. DHS 105.19 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91; emerg. r. and recr., eff. 7-1-92; r. and recr. Register, February, 1993, No. 446, eff., 3-1-93; corrections in (1) (a) (intro.), (b) and (10) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 20-039: am. (1) (b) Register October 2021 No. 790, eff. 11-1-21; EmR2306: emerg. cr. (7m), eff. 5-1-23; CR 23-045: cr. (7m) Register January 2024 No. 817, eff. 2-1-24. DHS 105.20(1)(1) Qualifications. For MA certification, a nurse practitioner shall be licensed as a registered nurse pursuant to s. 441.06, Stats., and fulfill one of the following requirements: DHS 105.20(1)(a)(a) If practicing as a pediatric nurse practitioner, be currently certified by the American nurses’ association or by the national board of pediatric nurse practitioners and associates; DHS 105.20(1)(b)(b) If practicing as any family nurse practitioner, be currently certified by the American nurses’ association; or DHS 105.20(1)(c)(c) If practicing as any other primary care nurse practitioner or as a clinical nurse specialist, be currently certified by the American nurses’ association, the national certification board of pediatric nurse practitioners and associates, or the nurses’ association of the American college of obstetricians and gynecologists’ certification corporation, or have a master’s degree in nursing from a school accredited by a program designed to prepare a registered nurse for advanced clinical nurse practice. DHS 105.20(2)(2) Protocols. A written protocol covering a service or delegated medical act that may be provided and procedures that are to be followed for provision of services by nurse practitioners shall be developed and maintained by the nurse practitioner and the delegating licensed physician according to the requirements of s. N 6.03 (2) and the guidelines set forth by the board of nursing. This protocol shall include, but is not limited to, explicit agreements regarding those delegated medical acts which the nurse practitioner or clinical nurse specialist is delegated by the physician to provide. A protocol shall also include arrangements for communication of the physician’s directions, consultation with the physician, assistance with medical emergencies, patient referrals and other provisions relating to medical procedures and treatment. DHS 105.20 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91. DHS 105.201DHS 105.201 Nurse-midwives. For MA certification, a nurse midwife shall be certified as a registered nurse under s. DHS 105.19 (1) and shall be certified as a nurse midwife under ch. N 4. DHS 105.201 HistoryHistory: Cr. Register, January, 1991, No. 421, eff. 2-1-91. DHS 105.21(1)(1) Requirements. For MA certification, a hospital which is an institution for mental disease (IMD) shall: DHS 105.21(1)(a)1.1. Maintain clinical records on all patients, including records sufficient to permit determination of the degree and intensity of treatment furnished to MA recipients, as specified in 42 CFR 482.61; and DHS 105.21(1)(a)2.2. Maintain adequate numbers of qualified professional and supportive staff to evaluate patients, formulate written, individualized comprehensive treatment plans, provide active treatment measures and engage in discharge planning, as specified in 42 CFR 482.62; DHS 105.21(1)(c)(c) If participating in the PRO review program, meet the requirements of that program and any other requirements established under the state contract with the PROs; DHS 105.21(2)(2) Waivers and variances. The department shall consider applications for waivers or variances of the requirements in sub. (1) if the requirements and procedures stated in s. DHS 106.11 are followed. DHS 105.21 NoteNote: For covered mental health services, see s. DHS 107.13. DHS 105.21 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) (a) made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1990, No. 414; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636. DHS 105.22(1)(1) Types of psychotherapy providers. For MA certification, a psychotherapy provider shall be one of the following: DHS 105.22(1)(a)(a) A physician meeting the requirements of s. DHS 105.05 (1) who has completed a residency in psychiatry. Proof of residency shall be provided to the department. Proof of residency shall either be board-certification from the American board of psychiatry and neurology or a letter from the hospital in which the residency was completed; DHS 105.22(1)(bm)(bm) An advanced practice nurse prescriber who is certified under s. 441.16 (2), Stats., and holds current certification in a psychiatric specialty from the American Nurses Credentialing Center. DHS 105.22(1)(bo)(bo) A professional counselor licensed under ss. 457.12 to 457.14, Stats., including holding a valid training or temporary license; DHS 105.22(1)(d)(d) A hospital outpatient mental health clinic located on the hospital’s physical premises. DHS 105.22(2)(2) Staffing of outpatient facilities. To provide psychotherapy reimbursable by MA, personnel employed by an outpatient clinic under sub. (1) (c) shall meet applicable requirements under ch. DHS 35. Persons employed by a hospital outpatient mental health clinic under sub. (1) (d) need not be individually certified as providers but may provide psychotherapy services upon the department’s issuance of certification to the mental health clinic by which they are employed. A hospital outpatient mental health clinic shall maintain a list of the names of persons employed by the clinic who are performing psychotherapy services for which reimbursement may be claimed under MA. This listing shall document the credentials possessed by the named persons which would qualify them for certification under the standards specified in this subsection and shall include the dates that the named persons began employment. DHS 105.22(3)(3) Reimbursement for outpatient psychotherapy services. Reimbursement shall be made to any certified psychotherapy provider whose practice, as described by individual licensure or clinic certification regulations, allows for the delivery of psychotherapy without clinical supervision. For outpatient psychotherapy services delivered by certified providers who are required, under individual licensure or clinic certification regulations, to practice under a clinical supervisor, reimbursement shall be made to the supervising provider. The supervising provider must be MA certified. DHS 105.22 NoteNote: For covered mental health services, see s. DHS 107.13. DHS 105.22 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (c), (d) and (2) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 06-080: cr. (1) (bm), am. (1) (c), (2) (a) and (3), r. and recr. (1) (d), r. (2) (b) Register May 2009 No. 641, eff. 6-1-09; correction in (2) made under s. 13.92 (4) (b) 1., Stats., Register May 2009 No. 641; CR 20-039: am. (1) (b), cr. (1) (bn) to (br), am. (3) Register October 2021 No. 790, eff. 11-1-21. DHS 105.23DHS 105.23 Alcohol and other drug abuse (AODA) treatment providers. DHS 105.23(1)(1) Types of providers. For MA certification, an outpatient alcohol and other drug abuse (AODA) treatment provider shall be: DHS 105.23(2)(a)(a) To provide AODA services reimbursable under MA, personnel employed by an outpatient facility under sub. (1) (a) or (b) shall: DHS 105.23(2)(a)2.2. Be an AODA counselor certified by the Wisconsin alcoholism and drug abuse counselor certification board and work under the supervision of a provider who is a licensed physician or licensed psychologist and employed by the same facility. DHS 105.23 NoteNote: Certification standards of the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board may be obtained by writing the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board, Inc., 416 East Main Street, Waukesha, WI 53186.
DHS 105.23(2)(b)(b) The facility shall provide the department with a list of persons employed by the facility who perform AODA services for which reimbursement may be claimed under MA. The listing shall identify the credentials possessed by the named persons which would qualify them for certification under the standards specified in par. (a). A facility, once certified, shall promptly advise the department in writing of the employment or termination of employees who will be or have been providing AODA services under MA. DHS 105.23(3)(3) Reimbursement for AODA services. Reimbursement for outpatient AODA treatment services shall be as follows: DHS 105.23(3)(a)(a) For the services of any provider employed by or under contract to a certified AODA facility, reimbursement shall be made to the facility; and DHS 105.23(3)(b)(b) For the services of any provider who is a physician or licensed psychologist defined under sub. (1) (c) in private practice, reimbursement shall be to the physician or psychologist. DHS 105.23 NoteNote: For covered alcohol and other drug abuse treatment services, see s. DHS 107.13 (3). DHS 105.23 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (b) and(c) and (2) (a) 1., Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (a) and (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections in (1) (a) and (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 20-039: am. (1) (c) Register October 2021 No. 790, eff. 11-1-21; correction in (1) (c) made under s. 35.17, Stats., Register October 2021 No. 790; correction in (1) (a), (b) made under s. 13.92 (4) (b) 7., Stats., Register September 2022 No. 801. DHS 105.24DHS 105.24 Mental health day treatment or day hospital service providers. DHS 105.24(1)(1) Requirements. For MA certification, a day treatment or day hospital service provider shall: DHS 105.24(1)(b)1.1. A registered nurse and a registered occupational therapist shall be available to participate in program planning, program implementation and daily program coordination; DHS 105.24(1)(b)2.2. The day treatment program shall be planned for and directed by designated members of an interdisciplinary team that includes a social worker, a psychologist, an occupational therapist and a registered nurse or a physician, physician’s assistant or another appropriate health care professional; DHS 105.24(1)(b)3.3. A written patient evaluation involving an assessment of the patient’s progress by each member of the multidisciplinary team shall be made at least every 60 days; and DHS 105.24(1)(b)4.4. For the purposes of daily program performance, coordination guidance and evaluation: DHS 105.24(1)(b)4.a.a. One qualified professional staff member such as an OTR, masters degree social worker, registered nurse, licensed psychologist or masters degree psychologist for each group, or one certified occupational therapy assistant and one other paraprofessional staff person for each group; and DHS 105.24(2)(a)(a) Reimbursement for medical day treatment or day hospital services shall be at a rate established and approved by the department. DHS 105.24(2)(b)(b) Reimbursement payable under par. (a) shall be subject to reductions for third party recoupments. DHS 105.24 NoteNote: For covered day treatment and day hospital services, see s. DHS 107.13 (4). DHS 105.24 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. (1) (a), am. (2) (b), r. (2) (c), Register, September, 1991, No. 429, eff. 10-1-91; correction in (1) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 22-043: am. (1) (b) 1. Register May 2023 No. 809, eff. 6-1-23. DHS 105.25DHS 105.25 Alcohol and other drug abuse (AODA) day treatment providers. DHS 105.25(1)(1) Types of providers. For MA certification, an alcohol and other drug abuse (AODA) day treatment provider shall be certified under ss. DHS 75.52 and 105.23. DHS 105.25(2)(a)(a) An alcohol and drug counselor certified as provided in ss. DHS 75.02 (84) and 75.03 (4) (d) shall be available during all hours in which services are provided to participate in treatment planning and implementation and daily program coordination. DHS 105.25(2)(b)(b) A treatment plan for each participating recipient shall be developed, directed and monitored by designated members of an interdisciplinary treatment team which includes an alcohol and drug counselor II or III, certified as provided in ss. DHS 75.03 (85) and 75.18 (2) (c) and (6) (b), a physician or licensed psychologist, and other health care professionals. The treatment team shall maintain a written record of each recipient’s treatment and progress toward meeting the goals described in the recipient’s plan of care. DHS 105.25(2)(c)(c) All treatment shall be coordinated and provided by at least one qualified professional staff member who has demonstrated experience in delivering direct treatment to persons with alcohol and other drug abuse problems. Other staff members, such as an AODA counselor I who has filed for certification with the Wisconsin alcoholism and drug counselor certification board, inc., may assist in treatment under the supervision of a qualified professional staff member. DHS 105.25 HistoryHistory: Emerg. cr. eff. 3-9-89; cr. Register, December, 1989, No. 408, eff. 1-1-90; corrections in (1), (2) (a) and (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; correction in (1), (2) (a), (b) made under s. 13.92 (4) (b) 7., Stats., Register September 2022 No. 801; CR 22-043: am. (2) (a) Register May 2023 No. 809, eff. 6-1-23. DHS 105.255(1)(1) General requirements. For MA certification, a community support program (CSP) service provider shall meet the requirements under ss. DHS 63.06 to 63.17 and this section. The department may waive a requirement in ss. DHS 63.06 to 63.17 under the conditions specified in s. DHS 63.05 if requested by a provider. Certified providers under this section may provide services directly or may contract with other qualified providers to provide all or some of the services described in s. DHS 107.13 (6).
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Chs. DHS 101-109; Medical Assistance
administrativecode/DHS 105.21(1)(f)
administrativecode/DHS 105.21(1)(f)
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